Systematic review of Acceptance and Commitment Therapy interventions for eating disorders
DOI:
https://doi.org/10.70478/Keywords:
Acceptance and commitment therapy, Eating disorders , Body dissatisfaction , Efficacy , Mechanisms of changeAbstract
Introduction: The present systematic review aims to examine the efficacy of interventions based on Acceptance and Commitment Therapy (ACT) for eating disorders and body dissatisfaction, and analyze the mediating variables underlying its efficacy, connecting processes to outcomes. Method: 19 articles were analyzed from a total of 639 identified registers following the PRISMA guidelines. Sources of information: PsycARTICLES, PsycINFO, Scopus, Bun!, Psychology and Behavioural Sciences Collection and PSICODOC. Results: Despite the theoretical adequacy of ACT for this issue and the existence of positive findings supporting its efficacy, results should be interpreted with caution. Discussion: The inconsistency of the results could stem from a lack of conceptual clarity regarding the psychological flexibility model, from methodological deficiencies in the design -that limit the capacity to isolate the intervention effects-, and the lack of measurements during the treatment application. Subsequent research would benefit from establishing more adjusted and
operative definitions about the mechanisms of change, as well as using assessment tools that allow for a more precise analysis of the role of psychological flexibility and of its components. Limitations: Future research should include quality assessments and effect size measures, and broaden the sources consulted.
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Ahmed, Fatema; Wu, Chen; Li, Li; Ye, Qingyuan; Ksebe, Waleed y Wang, Kefang (2025). Psychological approaches for eating disorders: The role of body image, self-esteem, and quality of life. En F. Durbano, F. Irtelli y B. Marchesi (Eds.), Psychotherapy in the third millennium - Cross-cutting themes and proposals for reflection. Intech Open. https://doi.org/10.5772/intechopen.1009601
Barney, Jennifer L.; Murray, Helen B.; Manasse, Stephanie M.; Dochat, Cara y Juarascio, Adrienne S. (2019). Mechanisms and moderators in mindfulness-and acceptance-based treatments for binge eating spectrum disorders: A systematic review. European Eating Disorders Review, 27(4), 352–380. https://doi.org/10.1002/erv.2673
* Berman, Margit I.; Boutelle, Kerri. N. y Crow, Scott J. (2009). A case series investigating acceptance and commitment therapy as a treatment for previously treated, unremitted patients with anorexia nervosa. European Eating Disorders Review, 17(6), 426–434. https://doi.org/10.1002/erv.962
Biglan, Anthony y Hayes, Steven C. (1996). Should the behavioral sciences become more pragmatic? The case for functional contextualism in research on human behavior. Applied & Preventive Psychology, 5(1), 47–57. https://doi.org/10.1016/S0962-1849(96)80026-6
Bond, Frank W.; Hayes, Steven C.; Baer, Ruth A.; Carpenter, Kenneth M.; Guenole, Nigel; Orcutt, Holly K.; Waltz, Tom y Zettle, Robert D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42(4), 676–688. https://doi.org/10.1016/j.beth.2011.03.007
Carrasco, Tomás J. y Adame, María L. (2000). Una alternativa científica a la comprensión y el tratamiento de la anorexia y bulimia nerviosas: El análisis funcional de la conducta. En María Lameiras Fernández y José María Faílde Garrido (Coords.), Trastornos de la conducta alimentaria. Del tratamiento a la prevención (pp. 65–86). Universidad de Vigo.
Chew, Han Shi Jocelyn; Chng, Samuel; Rajasegaran, Nagadarshini Nicole; Choy, Khun Hean y Chong, Yuen Yu (2023). Effectiveness of acceptance and commitment therapy on weight, eating behaviours and psychological outcomes: A systematic review and meta-analysis. Eating and Weight Disorders, 28, 6. https://doi.org/10.1007/s40519-023-01535-6
Cuthbert, Bruce N. (2022). Research Domain Criteria (RDoC): Progress and Potential. Current Directions in Psychological Science, 31(2), 107-114. https://doi.org/10.1177/09637214211051363
Di Sante, Jessica; Akeson, Bianca; Gossack, Amanda y Knäuper, Bärbel (2022). Efficacy of ACT-based treatments for dysregulated eating behaviours: A systematic review and meta-analysis. Appetite, 171, 105929. https://doi.org/10.1016/j.appet.2022.105929
Du, Shizheng; Dong, Jianshu; Jin, Shengji; Zhang, Heng y Zhang, Yuqun (2021). Acceptance and commitment therapy for chronic pain conditions on functioning: A systematic review protocol. Journal of Advanced Nursing, 77(1), 417–426. https://doi.org/10.1111/jan.14575
Fairburn, Christopher G.; Cooper, Zafra y Shafran, Roz (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41(5), 509–528. https://doi.org/10.1016/S0005-7967(02)00088-8
* Fang, Shuanghu; Ding, Dongyan; Ji, Pingping; Huang, Mingjie y Hu, Kesong (2022). Cognitive defusion and psychological flexibility predict negative body image in the Chinese college students: Evidence from acceptance and commitment therapy. International Journal of Environmental Research and Public Health, 19(24), 16519. https://doi.org/10.3390/ijerph192416519
Fernández-Montes, Isabel; Cabañas, Verónica y Casanova, Irene (2018). Tratamiento de un caso de trastorno de la conducta alimentaria desde la perspectiva de aceptación y compromiso. Revista de Casos Clínicos en Salud Mental, 6(1), 85–117. https://dialnet.unirioja.es/servlet/oaiart?codigo=6642694
* Fogelkvist, Maria; Gustafsson, Sanna Aila; Kjellin, Lars y Parling, Thomas (2020). Acceptance and commitment therapy to reduce eating disorder symptoms and body image problems in patients with residual eating disorder symptoms: A randomized controlled trial. Body Image, 32, 155–166. https://doi.org/10.1016/j.bodyim.2020.01.002
* Fogelkvist, Maria; Gustafsson, Sanna Alia; Kjellin, Lars y Parling, Thomas (2022). Predictors of outcome following a body image treatment based on acceptance and commitment therapy for patients with an eating disorder. Journal of Eating Disorders, 10, 90. https://doi.org/10.1186/s40337-022-00615-9
* Frayn, Mallory; Khanyari, Sabrah y Knäuper, Bärbel (2019). A 1-day acceptance and commitment therapy workshop leads to reductions in emotional eating in adults. Eating and Weight Disorders, 25(5), 1399-1411. https://doi.org/10.1007/s40519-019-00778-6
García-Rasero, Alba María y Tamayo-Hernández, José Antonio (2019). Revisión sistemática sobre la eficacia de la terapia de aceptación y compromiso (ACT) en el tratamiento psicológico de pacientes con cáncer. Psicooncologia, 16(1), 101–125. https://doi.org/10.5209/ PSIC.63651
Gloster, Andrew T.; Walder, Noemi; Levin, Michael E.; Twohig, Michael P. y Karekla, Maria (2020). The empirical status of acceptance and commitment therapy: A review of meta-analyses. Journal of Contextual Behavioral Science, 18, 181–192. https://doi.org/10.1016/j.jcbs.2020.09.009
González-Blanch, César y Carral-Fernández, Laura (2017). ¡Enjaulad a Dodo, por favor! El cuento de que todas las psicoterapias son igual de eficaces. Papeles del Psicólogo, 37(1), 94–106. https://doi.org/10.23923/pap.psicol2017.2828
González-Terrazas, Raymundo y Froxán-Parga, María Xesús (2021). Saber qué y saber cómo: Una propuesta explicativa de tres técnicas terapéuticas empíricamente validadas. Clínica Contemporánea: Revista de Diagnóstico Psicológico, Psicoterapia y Salud, 3(12), 1-16. https://doi.org/10.5093/cc2021a22
Griffiths, Catrin; Williamson, Heidi; Zucchelli, Fabio; Paraskeva, Nicole y Moss, Tim (2018). A systematic review of the effectiveness of acceptance and commitment therapy (ACT) for body image dissatisfaction and weight self-stigma in adults. Journal of Contemporary Psychotherapy, 48(4), 189–204. https://doi.org/10.1007/s10879-018-9384-0
Hayes, Steven C. (1993). Analytic goals and the varieties of scientific contextualism. En Steven C. Hayes; Linda J. Hayes; Hayne W. Reese y Theodore R. Sarbin (Eds.), Varieties of scientific contextualism (pp. 11–27). Context Press.
Hayes, Steven C.; Barnes-Holmes, Dermot y Roche, Bryan (2001). Relational frame theory: A post-skinnerian account of human language and cognition. Kluwer Academic/Plenum Publishers. https://doi.org/10.1007/b108413
Hayes, Steven C. y Follette, William C. (1992). Can functional analysis provide a substitute for syndromal classification? Behavioral Assessment, 14(3-4), 345–365.
Hayes, Steven C.; Luoma, Jason B.; Bond, Frank W.; Masuda, Akihiko y Lillis, Jason (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25. https://doi.org/10.1016/j.brat.2005.06.006
Hayes, Steven C.; Strosahl, Kirk D. y Wilson, Kelly G. (2012). Acceptance and commitment therapy: The process and practice of mindful change. Guilford Press.
* Heffner, Michelle; Sperry, Jeannie; Eifert, Georg H. y Detweiler, Michael (2002). Acceptance and commitment therapy in the treatment of an adolescent female with anorexia nervosa: A case example. Cognitive and Behavioral Practice, 9(3), 232–236. https://doi.org/10.1016/S1077-7229(02)80053-0
* Hill, Mary L.; Masuda, Akihiko; Melcher, Hailey; Morgan, Jessica R. y Twohig, Michael P. (2015). Acceptance and commitment therapy for women diagnosed with binge eating disorder: A case-series study. Cognitive and Behavioral Practice, 22(3), 367–378. https://doi.org/10.1016/j.cbpra.2014.02.005
* Hill, Mary L.; Masuda, Akihiko; Moore, Makeda y Twohig, Michael P. (2014). Acceptance and commitment therapy for individuals with problematic emotional eating: A case-series study. Clinical Case Studies, 14(2), 141–154. https://doi.org/10.1177/1534650114547429
* Hill, Mary L.; Schaefer, L. Ward; Spencer, Samuel D. y Masuda, Akihiko (2020). Compassion-focused acceptance and commitment therapy for women with restrictive eating and problematic body-checking: A multiple baseline across participants study. Journal of Contextual Behavioral Science, 16, 144–152. https://doi.org/10.1016/j.jcbs.2020.04.006
Insel, Thomas R. (2017). Digital phenotyping: Technology for a new science of behavior. JAMA, 318(13), 1215–1216. https://doi.org/10.1001/jama.2017.11295
Insel, Thomas R. y Cuthbert, Bruce N. (2015). Brain disorders? Precisely. Science, 348(6234), 499-500. https://doi.org/10.1126/science.aab2358
* Juarascio, Adrienne S.; Forman, Evan M. y Herbert, James D. (2010). Acceptance and commitment therapy versus cognitive therapy for the treatment of comorbid eating pathology. Behavior Modification, 34(2), 175–190. https://doi.org/10.1177/0145445510363472
* Juarascio, Adrienne S.; Schumacher, Leah M.; Shaw, Jena; Forman, Evan M. y Herbert, James D. (2015). Acceptance-based treatment and quality of life among patients with an eating disorder. Journal of Contextual Behavioral Science, 4(1), 42–47. https://doi.org/10.1016/j.jcbs.2014.11.002
* Juarascio, Adrienne; Shaw, Jena; Forman, Evan; Timko, C. Alix; Herbert, James; Butryn, Meghan; Bunnell, Douglas; Matteucci, Alyssa y Lowe, Michael (2013a). Acceptance and commitment therapy as a novel treatment for eating disorders: An initial test of efficacy and mediation. Behavior Modification, 37(4), 459–489. https://doi.org/10.1177/0145445513478633
Juarascio, Adrienne; Shaw, Jena; Forman, Evan M.; Timko, C. Alix, Herbert, James D.; Butryn, Meghan L. y Lowe, Michael (2013b). Acceptance and commitment therapy for eating disorders: Clinical applications of a group treatment. Journal of Contextual Behavioral Science, 2(3-4), 85-94. https://doi.org/10.1016/j.jcbs.2013.08.001
* Karekla, Maria; Nikolaou, Patrisia y Merwin, Rhonda M. (2022). Randomized clinical trial evaluating AcceptME—A digital gamified acceptance and commitment early intervention program for individuals at high risk for eating disorders. Journal of Clinical Medicine, 11(7), 1775. https://doi.org/10.3390/jcm11071775
Kater, Kathy (2010). New pathways: Applying acceptance and commitment therapy to the treatment of eating disorders. En M. Maine, B. H. McGuilley y D. W. Bunnell (Eds.), Treatment of eating disorders: Bridging the research–practice gap (pp. 163–180). Elsevier Academic Press. https://doi.org/10.1016/B978-0-12-375668-8.10010-5
Manlick, Christopher F.; Cochran, Sam V. y Koon, Jerrod (2013). Acceptance and commitment therapy for eating disorders: Rationale and literature review. Journal of Contemporary Psychotherapy, 43(2), 115–122. https://doi.org/10.1007/s10879-012-9223-7
* Marco-Cramer, Maria; Quiles-Marcos, Yolanda y Quiles-Sebastián, María José (2018). Aplicación de la terapia de aceptación y compromiso en pacientes con un trastorno de la conducta alimentaria: Un estudio piloto. Informació Psicològica, 116, 18–31.
* Margolis, Susan E. y Orsillo, Susan M. (2016). Acceptance and body dissatisfaction: Examining the efficacy of a brief acceptance based intervention for body dissatisfaction in college women. Behavioural and Cognitive Psychotherapy, 44(4), 482–492. https://doi.org/10.1017/S1352465816000072
* Masuda, Akihiko; Ng, Stacey Y.; Moore, Makeda; Felix, Isabelle y Drake, Chad E. (2016). Acceptance and commitment therapy as a treatment for a Latina young adult woman with purging: A case report. Practice Innovations, 1(1), 20–35. https://doi.org/10.1037/pri0000012
McLean, Siân A. y Paxton, Susan J. (2019). Body image in the context of eating disorders. Psychiatric Clinics of North America, 42(1), 145–156. https://doi.org/10.1016/j.psc.2018.10.006
McLoughlin, Shane y Roche, Bryan T. (2023). ACT: A process-based therapy in search of a process. Behavior Therapy, 54(6), 939–955. https://doi.org/10.1016/j.beth.2022.07.010
* Merwin, Rhonda M.; Nikolaou, Patrisia; Moskovich, Ashley A.; Babyak, Michael; Smith Patrick J. y Karekla, Maria (2023). Change in body image flexibility and correspondence with outcomes in a digital early intervention for eating disorders based on acceptance and commitment therapy. Body Image, 44, 131–135. https://doi.org/10.1016/j.bodyim.2022.12.010
Mills, Jennifer S.; Polivy, Janet; Herman, C. Peter y Tiggemann, Marika (2002). Effects of exposure to thin media images: Evidence of self-enhancement among restrained eaters. Personality and Social Psychology Bulletin, 28(12), 1687-1699. https://doi.org/10.1177/014616702237650
Molenaar, P.C.M. (2008). On the implications of the classical ergodic theorems: Analysis of developmental processes has to focus on intra-individual variation. Developmental Psychobiology, 50(1), 60-69. https://doi.org/10.1002/dev.20262
Moskovich, Ashley A. (2014). Maladaptive rule-governed behavior in anorexia nervosa: The need for certainty and control [Doctoral thesis, 43Terapia de Aceptación y Compromiso Para Problemas de la Conducta Alimentaria Duke University]. Duke University ProQuest Dissertations & Theses. https://core.ac.uk/download/pdf/37750224.pdf
Onnink, Carly M.; Konstantinidou, Yvoni; Moskovich, Ashley A.; Karekla, Maria K. y Merwin, Rhonda M. (2022). Acceptance and commitment therapy (ACT) for eating disorders: A systematic review of intervention studies and call to action. Journal of Contextual Behavioral Science, 26, 11–28. https://doi.org/10.1016/j.jcbs.2022.08.005
Page, Matthew J.; McKenzie, Joanne E.; Bossuyt, Patrick M.; Boutron, Isabelle; Hoffmann, Tammy C.; Mulrow, Cynthia D.; Shamseer, Larissa; Tetzlaff, Jennifer M.; Akl, Elie A.; Brennan, Sue E.; Chou, Roger; Glanville, Julie; Grimshaw, Jeremy M.; Hróbjartsson, Asbjørn; Lalu, Manoj M.; Li, Tianjing; Loder, Elizabeth W.; Mayo-Wilson, Evan; McDonald, Steve; … Moher, David (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372. https://doi.org/10.1136/bmj.n71
* Parling, Thomas; Cernvall, Martin; Ramklint, Mia; Holmgren, Sven y Ghaderi, Ata (2016). A randomised trial of acceptance and commitment therapy for anorexia nervosa after daycare treatment, including five-year follow-up. BMC Psychiatry, 16, 272. https://doi.org/10.1186/s12888-016-0975-6
* Pearson, Adria N.; Follette, Victoria M. y Hayes, Steven C. (2012). A pilot study of acceptance and commitment therapy as a workshop intervention for body dissatisfaction and disordered eating attitudes. Cognitive and Behavioral Practice, 19(1), 181–197. https://doi.org/10.1016/j.cbpra.2011.03.001
Philip, Joel y Cherian, Vinu (2021). Acceptance and commitment therapy in the treatment of obsessive-compulsive disorder: A systematic review. Journal of Obsessive-Compulsive and Related Disorders, 28, 100603. https://doi.org/10.1016/j.jocrd.2020.100603
Rohde, Paul; Stice, Eric y Marti, C. Nathan (2014). Development and predictive effects of eating disorder risk factors during adolescence: Implications for prevention efforts. International Journal of Eating Disorders, 48(2), 187–198. https://doi.org/10.1002/eat.22270
Timimi, Sami (2014). No more psychiatric labels: Why formal psychiatric diagnostic systems should be abolished. International Journal of Clinical and Health Psychology, 14(3), 208-215. http://doi.org/10.1016/j.ijchp.2014.03.004
Timko, C. Alix; Juarascio, Adrienne S.; Martin, Lindsay M.; Faherty, Ashley y Kalodner, Cynthia (2014). Body image avoidance: An under-explored yet important factor in the relationship between body image dissatisfaction and disordered eating. Journal of Contextual Behavioral Science, 3(3), 203–211. https://doi.org/10.1016/j.jcbs.2014.01.002
Tyndall, Ian; Waldeck, Daniel; Pancani, Luca; Whelan, Robert; Roche, Bryan y Dawson, David L. (2019). The Acceptance and Action Questionnaire-II (AAQ-II) as a measure of experiential avoidance: Concerns over discriminant validity. Journal of Contextual Behavioral Science, 12, 278–284. https://doi.org/10.1016/j.jcbs.2018.09.005
Virués-Ortega, Javier y Miguel, Caio F. (2013). Análisis funcional de la conducta verbal. En Raymond G. Miltenberger (Ed.), Modificación de conducta: Principios y procedimientos (pp. 483-501). Pirámide.
Wolgast, Martin (2014). What does the Acceptance and Action Questionnaire (AAQ-II) really measure? Behavior Therapy, 45(6), 831–839. https://doi.org/10.1016/j.beth.2014.07.002
Wulfert, Edelgard; Greenway, David E.; Farkas, Paula; Hayes, Steven C. y Dougher, Michael J. (1994). Correlation between self-reported rigidity and rule-governed insensitivity to operant contingencies. Journal of Applied Behavior Analysis, 27(4), 659–671. https://doi.org/10.1901/jaba.1994.27-659
Zettle, Robert D. (2020). Treatment manuals, single-subject designs, and evidence-based practice: A clinical behavior analytic perspective. The Psychological Record, 70(4), 649-658. https://doi.org/10.1007/s40732-020-00394-2
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